Tanju KETEN, Ali Yasin OZERCAN, Burak KÖSEOĞLU, Ahmet Burak YILMAZ, Ünsal EROĞLU, Yalçın KIZILKAN, Melih BALCI, Özer GÜZEL, Yılmaz ASLAN, Cüneyt ÖZDEN, Altuğ TUNCEL

The Effect of Preservation of the Bladder Neck on Incontinence Rates in Patients Who Undergo Robot-Assisted Laparoscopic Radical Prostatectomy

Introduction: We aimed to compare the postoperative continence rates in prostate cancer patients who had robot-assisted radical prostatectomy (RARP) when bladder necks were “unpreserved”, “preserved” and “extremely preserved”. Methods: In this study, the data of 184 patients who underwent RARP for localized prostate cancer in our clinic between August 2019 and January 2023 were analyzed. The patients were divided into three groups as the bladder neck was not preserved (Group 1), the bladder neck was preserved (Group 2), and the bladder neck was extremely preserved (Group 3). Incontinence status was evaluated with the 24-hour pad test postoperatively at the 1st, 3rd 6th month and 12th months. Results: One month after surgery, the rate of fully continent patients was higher in Group 3 (39.1%) than Groups 1 and 2 (27.5% and 32.7%, respectively), however the difference was not statistically significant (p=0.483). At the postoperative 3rd month, the rate of fully continent patients was 56.5% in Group 3, 51.9% in Group 2 and 43.1% in Group 1 (p=0.361). The rate of patients with moderate incontinence was higher in Group 1 compared to other study groups (p=0.019). The rate of fully continent patients was 82.6% in Group 3, 73.1% in Group 2 and 61.5% in Group 1 at 6th postoperative month (p=0.079). At postoperative 6 month a significant difference was observed for moderate incontinence rates (15.6%, 5.8% and 0 for Groups 1, 2 and 3, respectively) (p=0.034). At the postoperative 12th month, the rate of fully continent patients was 91.3% in Group 3, 80.8% in Group 2 and 72.5% in Group 1 (p=0.118). Conclusion: Our results indicated that the approaches for preserving the bladder neck during RARP did not have a statistically significant effect on the prevalence of incontinence, however reduced the severity of incontinence.

Keywords:

Bladder neck sparing, Postprostatectomy incontinence, Robot-assisted radical prostatectomy,

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1. Okhawere KE, Shih IF, Lee SH, et al. Comparison of 1-Year Health Care Costs and Use Associated With Open vs Robotic-Assisted Radical Prostatectomy. JAMA Netw Open. 2021;4(3):e212265.
2. Ilic D, Evans SM, Allan CA, et al. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9(9):CD009625.
3. Moretti TBC, Magna LA, Reis LO. Surgical Results and Complications for Open, Laparoscopic, and Robot-assisted Radical Prostatectomy: A Reverse Systematic Review. Eur Urol Open Sci. 2022;44:150-161.
4. d’Altilia N, Mancini V, Falagario UG, et al. A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques. Cancers (Basel). 2022;14(18):4350.
5. Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057-66.
6. Haglind E, Carlsson S, Stranne J, et al; LAPPRO steering committee. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. Eur Urol. 2015;68(2):216-25.
7. Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405-17.
8. Lavigueur-Blouin H, Noriega AC, Valdivieso R, et al. Predictors of early continence following robot-assisted radical prostatectomy. Can Urol Assoc J. 2015;9(1-2):e93-7.
9. Heo JE, Lee JS, Goh HJ, Jang WS, Choi YD. Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery. PLoS One. 2020;15(1):e0227744.
10. Yilmaz S, Ak E, Gazel E, et al. Bladder neck sparing during robot-assisted laparoscopic radical prostatectomy: Six-year experience. North Clin Istanb. 2021;8(3):269-74.
11. Dal Moro F, Zazzara M, Morlacco A, et al. Is “extreme” bladder neck preservation in robot-assisted radical prostatectomy a safe procedure? Urologia. 2020;87(3):149-54.
12. Kumar A, Litt ER, Ballert KN, Nitti VW. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence--what do patients choose? J Urol. 2009;181(3):1231-5.
13. Bauer RM, Bastian PJ, Gozzi C, Stief CG. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol. 2009;55(2):322-33.
14. Penson DF, Feng Z, Kuniyuki A, et al. General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the prostate cancer outcomes study. J Clin Oncol. 2003 Mar;21(6):1147-54.
15. Oelrich TM. The urethral sphincter muscle in the male. Am J Anat. 1980;158(2):229-46.
16. Steiner MS. The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. Urology. 1994;44(4):530-4.
17. von Bodman C, Matsushita K, Savage C, et al. Recovery of urinary function after radical prostatectomy: predictors of urinary function on preoperative prostate magnetic resonance imaging. J Urol. 2012;187(3):945-50.
18. Giannantoni A, Mearini E, Zucchi A, et al. Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study. Eur Urol. 2008;54(3):657-64.
19. Wei JT, Montie JE. Comparison of patients’ and physicians’ rating of urinary incontinence following radical prostatectomy. Semin Urol Oncol. 2000;18(1):76-80.
20. Arnsrud Godtman R, Persson E, Bergengren O, et al. Surgeon volume and patient-reported urinary incontinence after radical prostatectomy. Population-based register study in Sweden. Scand J Urol. 2022;56(5-6):343-50.
21. Walsh PC, Marschke PL. Intussusception of the reconstructed bladder neck leads to earlier continence after radical prostatectomy. Urology. 2002;59(6):934-8.
22. Preisser F, Busto Martin L, Pompe RS, et al. Effect of bladder neck sparing at robot-assisted laparoscopic prostatectomy on postoperative continence rates and biochemical recurrence. Urol Oncol. 2020;38(1):1.e11-1.e16.
23. Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol. 2009;56(6):972-80.
24. Sood A, Grauer R, Jeong W, et al. Evaluating post radical prostatectomy mechanisms of early continence. Prostate. 2022;82(12):1186-95.
25. Li X, Zhang H, Jia Z, et al. Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy. BMC Urol. 2020;20(1):29. Effect of Bladder-Neck Preservation on Incontinence